Urinary Tract Infections

Catharina Svanborg, Department of Medical Microbiology, Lund University, Lund, Sweden

Copyright © 1998 Elsevier Ltd. All Rights Reserved.

The term urinary tract infection (UTI) describes clinical conditions caused by the presence of microorganisms (usually bacteria but occasionally fungi or, more rarely, viruses or schistosomes) in the urinary tract. The severity of infection depends on the virulence of the infecting strain and responsiveness of the infected host. Urinary tract infections may therefore be seen as a spectrum of host responses to microorganisms of different virulence. The diagnostic categories used in clinical practice correspond to different parts of this spectrum: acute pyelonephritis is a febrile infection involving the kidney with signs of local and systemic inflammation as well as renal involvement. Acute cystitis is characterized by lower urinary tract symptoms with pain, frequency of micturition, and local inflammation but typically these patients lack signs of systemic infection. Screening of covert bacteriuria is used to describe patients in whom bacteriuria gives rise to few symptoms and is therefore only detected at screening.

UTIs are among the most common bacterial infections. The most reliable frequency estimates, based on extensive screening of different age groups, show that about 1% of schoolgirls, 2-11% of pregnant women and >10% of elderly women carry >105 bacteria ml"1 of urine. Men mostly acquire bacteriuria during the first year and the last decades of life. The cumulative frequency before 11 years of age of symptomatic infections is about 3.5% in girls and 1% in boys. While acute cystitis is common in women of all ages, the frequency estimates of acute pyelonephritis in adults vary extensively depending on underlying disease conditions.

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